S. J. Kim

P05.05: Facial dysmorphisms associated with holoprosencephaly

The primary aim of this study was to calculate, based on a mathematically modelled decision tree the cost effectiveness of the RM as an intervention for improving fetal medicine specialist’s decisions. Methods: 106 cases of fCNS were prospectively followed up until either termination of pregnancy (TOP) or postnatal follow up (PF). All of them underwent dedicated ultrasonographic (US) assessment and MR, at least once during prenatal evaluation. Neurological postnatal outcome and anatomo-pathology records were registered as gold standards. Positive and negative likelihood ratios (LR) were calculated for four specific regions: posterior fosa (PF), ventricular zone (VZ), cortex and subcortical region (CSC) and middle line (ML). After refinement of univariate analysis, a discriminative likelihood ratio (LR) was calculated for every region and technique, based on direct and indirect cost and calculated post-test probability a Markov’s chain was designed to modelate the real effectiveness of each test. Results: Table 1 summarizes LR results for region and technique, based on post test probabilities and costs, the probability of improving diagnosis with MR before 22 weeks is 15% for PF, 18,5% for VZ, 11% for CSC, 23% for ML, once modified the model for gestational age, the probability at 33 weeks increases to 53%, 78%, 65% and 42% respectively.

P44.09: Prenatal 3D US finding of esophageal atresia and tracheoesophageal fistula

Subjectively small or absent stomach bubble on classical ultrasound scan is associated with tracheoesophageal fistula/esophageal atresia and appropriate diagnosis of esophageal atresia (EA) significantly improve outcome. The antenatal diagnosis of esophageal atresia by the presence of polyhydroamniosis and an absent stomach bubble is well documented. A significant number of esophageal atresia are associated with a tracheoesophageal fistula. We present a case of long gap esophageal atresia with a fistula diagnosed prenatally by 3D US at 32 weeks 5days (Accuvix, Medison, korea). The 3D US findings are an absent stomach, polyhydroamnios, pouch sign of the esophageal blind end. After delivery, the baby had twice operations for long gap esophageal atresia with tracheoesophageal fistula (on the 11th day: tracheoesophageal fistula ligation with gastrostomy, on the 2 months later: intrathoracic esophagogastrostomy). Technique of reconstructing 3D volume is fast, accurate and produces high-quality images that are easy to reproduce of tracheal pouch.

P28.01: Three‐dimensional transvaginal ultrasound volumetry in normal pregnancies and missed abortion in first trimester

growth discordance. Amniocentesis on the normal twin showed a normal 46,XX karyotype. As pregnancy progressed the fetus with the cystic hygroma developed progressive hydrops with dramatic skin edema. The diagnosis of TRAP was suspected but could not be proven as the direction of flow in the umbilical artery could not be determined with confidence. In addition, there was persistent cardiac activity. At delivery, examination of the fetus and placenta confirmed TRAP sequence. TRAP sequence is a rare complication of twinning, occurring in approximately 1% of monochorionic gestations, or 1/35 000 births. The most common presentation is a grossly anomalous twin with no heart beat and reversed umbilical arterial flow. It is often mistaken for a twin gestation with an early demise. There are case reports of TRAP sequence presenting with initial cardiac activity in both fetuses. This case is unusual in that cardiac activity was present in the TRAP fetus throughout the 26 weeks of gestation. The pregnancy management would have been altered if the diagnosis could have been confirmed earlier. In MCDA pregnancies with an apparent anomalous twin, the direction of flow in the umbilical cord should be established as early as possible in order to diagnose TRAP sequence at the earliest opportunity.

P42.04: The differential diagnosis of bicornuate and septate uterine anomalies by three dimensional extended imaging (3D XI)™

Objectives: The aim of this study is to compare transperineal and endovaginal ultrasonography in the evaluation of the endometrium, assess for image quality and for a systematic difference in endometrial thickness measured by the two techniques. Methods: Transperineal and endovaginal ultrasonography evaluation of the endometrial thickness was performed on 58 women, in Dona Estefânia Hospital, between November 2005 and March 2007. Two physicians reviewed the images and rated the relative diagnostic value of the techniques for assessing the endometrial thickness. We identified two groups (G1 – visualized; G2 – not visualized). In G1 data were analyzed to determine if there is a correlation between the two approaches using the Spearman test, with a statistical significance of 5% (p < 0.05). In GI and G2 we concluded about the uterine position. Results: Fifty-eight women (average age 57.51) were divided in two groups (G1 n = 45; G2 n = 13). In G1 the Spearman test result was R = 0.933, which reveals a strong correlation between the two techniques. In this group 97.78% (44/45) of uterine position was anteversus or intermediary. In G2 the uterine positions were: anteversus 53.85% (7/13), intermediary 7.69% (1/13) and retroversus 38.46% (5/13). In the majority the transabdominal approach reveals worse quality images. Conclusions: Both transperineal and endovaginal ultrasonography can provide satisfactory images of the endometrium, but endovaginal images are frequently superior to transperineal images. With this study we can conclude that transperineal approach is correlated with endovaginal images for endometrial thickness evaluation, especially in anteversus and intermediary uterus. It had patient acceptance and tolerance, without the need for vaginal penetration, and could be a method of choice in virginal or in postmenopausal women with genital atrophy. This technique needs further study to validate its potential application.

P09.26: Prenatal massive subchorionic thrombohematoma diagnosed by 3D ultrasonography and MRI

– Healthy woman, 35 years old, Gravida2 para1, (Cesarean section four years ago performed by fetal malpresentation). In this recent pregnancy, the delivery occurred at 40 weeks of gestation by Vacuum and Forceps. The neonate was born with 4015g, I.A. 7/9. The succenturiata placenta was expelled late but spontaneously. The bleeding after was heavily and the woman was submitted a curettage of uterine cavity. This procedure was difficult (because a supposed myoma nodule) and no products were obtained. Meanwhile the anemia was present and needed 2U more 2U packed red cells transfusion. – Twenty hours after delivery, sonography was requested because the hemorrhage not stopped. – The examination was performed with GE Voluson 730. The images obtained strongly suggested Incomplete Uterine Inversion. – The woman was submitted a laparotomy and was confirmed the sonographic diagnosis of incomplete uterine inversion and yet a little rupture of the uterus (right1/3 of the scar of previous histerorraphy). – The reposition of the inverted uterus was very difficult (because the existence of a strong constriction ring) but possible. Next, it was performed the hysterorraphy and tubal sterilization.

P04.16: A case of fetal hydrops in maternal Sjogren's syndrome with distal renal tubular acidosis

Subsequently, one family disclosed a positive history of Marfan. The father had previous aortic root surgery for aortic dissection and ectopia lentis. In the twin pregnancy, the father is 1.90 m tall and had undergone echocardiography showing features suggestive of Marfan. In the other two families, there was no clear history of Marfan. The findings of dilated AAo in the fetus may be an indicator of prenatal manifestation of Marfan and a search for family history should be made. Aortic measurements should be verified by objective indicators such as Z-scores.

P03.15: Prenatal diagnosis of hydranencephaly using 2D and 3D ultrasound

Hydranencephaly is a severe brain condition characterized by complete or almost complete absence of cerebral cortex with preservation of meninges, basal ganglia, pons, falx. Despite the absence of the cerebral hemispheres, The thalami and lower brain centers are typically preserved. This condition is usually preceded by occlusion of the internal carotid arteries, infectious alterations (cytomegalovirus, toxoplasmosis) resulting in massive brain infarction. An 29-year-old woman, gravida 1, presented with fetal death at 18 weeks’ gestation. Initial 2D and 3D ultrasound revealed sloping forehead and abnormal intracerebral architecture which normal cerebral hemispheres could not be identified. Chromosomal study showed normal karyotyping. We report a case of hydranencephaly confirmed by autopsy, which was initially detected by 2D and 3 D ultrasonography at 18 weeks of gestation.

P14.45: Changing ultrasonographic features of a twisted fetal ovarian cyst during pregnancy

renal cortex and medulla with very mild pyelectasis and normal kidney dimensions. Neonatal scintigraphy of the kidneys revealed a completely non-functioning left kidney. No arterial hypertension was present at 3 months of life. Our case demonstrates that permanent lack of renal function can result from obstructive insult to the kidney in utero, despite normal prenatal and neonatal sonographic appearance.

P14.54: The effect of amniotic sheet diagnosed by prenatal ultrasonogram on the pregnancy outcome

Congenital teratomas of the umbilical cord are extremely rare. Only eleven case are known in the literature and two of those were associated with exomphalos. A 23-year old mother was performed a routine ultrasound examination in the 17 week of gestation. The ultrasonographic examination revealed a 49 × 25 mm midline sac adjacent to the anterior abdominal wall containing a solid and cystic mass. The parents asked for termination of pregnancy. The fetus weighed 131 g without the tumor. From 4 mm of the fetal end the cord contained a sac, measuring 5.5 × 6 × 6 cm, covered by transparent membranes. Fetal organs, small and large bowels with appendix, and the spleen were herniated into the exomphalos, as well as a solid and cystic tumor mass of 3 × 3.5 × 4 cm. Examination of the did not revealed any further malformation, histology of parenchymal organs showed normal development. The placenta was of normal size and shape but an unusual membranous sac was attached to the fetal surface, marginally. It was connected with the umbilical cord with an amniotic band. Microscopical examination of the tumor revealed complex structure consisting of various tissues from the three germinal layers. Mature tissue types were represented by well differentiated respiratory and intestinal glands, skin with dermal appendages, islets of cartilage, renal glomeruli, smooth muscle fibers, and ganglion cells, scattered in mesenchymal tissue. Large amount of immature neural tissue was present. Malignant component was not detected. The tumor was diagnosed as a benign immature umbilical cord teratoma. In the course of ultrasonographic scanning umbilical cord teratoma might be suspected when a solid and cystic, rapidly growing lesion is seen, attached to the cord in midline location. When the tumor is surrounded by membranous structures and hiding in an omphalocele the narrowing of the cord between the tumor and the abdominal wall could be a useful sign.

P115: Myometrial ectopic pregnancy of posterior uterine body diagnosed by 3D ultrasound

Background: Implantation anywhere else is an ectopic pregnancy. Ectopic pregnancy implanted in the myometrium of posterior uterine body was diagnosed by 3d ultrasound. Case report: We described interesting case of an myometrial ectopic pregnancy of posterior uterine body. A 28 year old woman was investigated for amenorrhea 7 weeks and vaginal bleeding. Past history said rt adnexectomy due to ovarian mass. Urine hcg was positive and sono was done. Sonographically no gestational sac was seen in uterus and adnexae, but gestational sac like mass was found in rt uterine body below cornual site by 3d ultrasound (Medison. Korea). A suspected gestational sac was removed by laparotomy. Laparotomy revealed a gestational sac and placental tissue on the lower back of the right uterine body above uterosacal area. Tissue pathology confirmed product of conceptus and materials.